San Antonio Breast Cancer Symposium 2012

voraciousreader

Starts Wednesday!!! Can't wait for the latest news!!! I'll be posting HERE!!!! Join me!!!!

cp418

SABCS: Using Molecular Assays for Breast Cancer in the Clinic

http://www.cancernetwork.com/conference-reports/sabcs2012/content/article/10165/2117513

cp418

http://www.medpagetoday.com/MeetingCoverage/SABCS/36234

Longer Tx to Be Focus for Breast Cancer Docs

beacon800

My onc just sent an email saying a presentation was just made that states 10 years of tamoxifen is more beneficial in terms of preventing recurrences.  Don't have all the details, such as side effects, but this does seem a big change from when 5 years was considered standard.

jenrio

This is interesting:  CDK inhibitor along with femara giving 26months PFS instead of <10 months PFS with femara alone.   Phase II trial only.   But still impressive.

http://www.fool.com/investing/businesswire/2012/12/05/pfizer-presents-phase-2-data-showing-investigation.aspx

cp418

Longer Tamoxifen Yields Greater Benefit

http://www.newswise.com/articles/extending-duration-of-adjuvant-tamoxifen-treatment-to-10-years-reduced-risk-for-late-breast-cancer-recurrence-improved-survival

http://www.medpagetoday.com/MeetingCoverage/SABCS/36272

voraciousreader

• Here are the links to the press releases from the symposium about today's released studies:
• http://www.sabcs.org/PressReleases/Documents/2012/9957ec3ea6c7a19b.pdf

 http://www.sabcs.org/PressReleases/Documents/2012/9b8a0237d44c7451.pdf

http://www.sabcs.org/PressReleases/Documents/2012/8390dd84eb522026.pdf

http://www.sabcs.org/PressReleases/Documents/2012/b5c378711895d6b3.pdf

http://www.sabcs.org/PressReleases/Documents/2012/a2e557cadd2e6212.pdf

 

kayfh

I really appreciate your work all of you intrepid posters.

wallycat

I just heard the tamoxifen comment on CNN.

Then I clicked on the medpage link and read the blurb.

Truly confused.

Here is where I would love to throw my look of hauty derision at some of this:

1.  No side effects were noted from the tamoxifen users (they clearly have not read the threads here.  How many oopherectomies and endo-biopsies will have to be done?).

2.  Tamoxifen for premenopausal women....(same medical people who say mammograms should start at 50)..and what do post meno and peri-meno gals do.

3.  Now they suspect only 1/3 cut not 1/2 of recurrence.......and it is a flaw that cannot be fixed, but we all know that no two women, even WITH the same cancer sub-types, responds the same in real life.  To have a control group is, in theory, already a flawed study.

Sorry to vent here but I cannot imagine being 55 and being told to go on this thing again.  

 

voraciousreader

http://www.boston.com/dailydose/2012/12/05/should-breast-cancer-patients-have-decade-tamoxifen/qTb1ynlNgl0jewwXNvubyM/story.html

"...On an individual level, however, breast cancer patients will need to weigh their options carefully. Endometrial cancer is a real risk, but it’s usually more common in older women over age 60. Patients should also realize that “the benefit isn’t huge, it’s modest,” Winer said.

And some women simply can’t tolerate tamoxifen and are eager to get off of the drug as quickly as possible. They might have hot flashes, moodiness, and vaginal dryness making sex very painful. “About 10 to 15 percent of women don’t like being on it,” Winer added, “and unfortunately, younger women seem to have more of these side effects.”

Those with small, non-aggressive tumors with no spread to nearby lymph nodes might consider only taking tamoxifen for five years if they’re plagued by side effects since their risk of recurrence is very small. Those with larger, more aggressive tumors, however, might feel more compelled to stay on the drug for a decade. 

For women whose breast cancer was diagnosed after menopause, the picture gets even more complicated. They’re usually given newer drugs called aromatase inhibitors (Arimidex, Femara, Aromasin) in addition to or instead of tamoxifen for a total of five years of treatment. Dana Farber patients typically get two years of tamoxifen followed by five years of aromatase inhibitors.

“I’ve long believed that these extra years of treatment would help,” said Winer. That’s because with estrogen-receptor positive cancers, half of all recurrences happen beyond five years of diagnosis.

“That was confusing to some of the oncologists at the meeting,” Winer said, but it could have to do with tamoxifen’s cancer-preventing benefits lasting for up to five years after women stop taking the drug.

Post-menopausal breast cancer patients could be given the option to take estrogen-blocking drugs for longer, but oncologists might be left in a quandary about which drugs to give and for how long. “Should these patients be given 10 years of treatment with an aromatase inhibitor? Should they have 5 years of an aromatase inhibitor followed by 5 years of tamoxifen? Would more than 10 years of tamoxifen be even better than 10 years? No data exist to support any of these options,” wrote Dr. Trevor Powles, an oncologist at the Cancer Centre London in England, in an editorial that accompanied the study..."

voraciousreader

http://www.obgynnews.com/index.php?id=11370&type=98&tx_ttnews[tt_news]=139037&cHash=da03e20e36

Breast Cancer: Molecular Profiling Doesn't Trump Standard Pathology

By: BRUCE JANCIN, Ob.Gyn. News Digital Network

12/05/12

  |

"SAN ANTONIO – Gene expression profile testing to guide decisions regarding the use of adjuvant chemotherapy for early-stage breast cancer should not be used to override the results of standard pathologic measures, Dr. Antonio C. Wolff asserted at the annual San Antonio Breast Cancer Symposium.

Two gene expression profile tests commonly used in breast cancer are the Oncotype DX and MammaPrint assays. The excitement surrounding this whole field is such that Dr. Wolff suspects many clinicians see the molecular assays as being superior to standard clinicopathologic data in their predictive information. This actually hasn’t been shown to be the case to date, he stressed.

Dr. Antonio C. Wolff

"One of the big messages I bring today is that one method is not necessarily better than the other. The standard pathologic tests and the molecular assays may be complementary in the information they provide," said Dr. Wolff, professor of oncology at Johns Hopkins University, Baltimore.

He added that while guideline-based use of these first-generation molecular assays as recommended by the American Society of Clinical Oncology (ASCO), the National Comprehensive Cancer Network (NCCN), and the European St. Gallen’s Expert Consensus group is appropriate, it’s important to recognize that these tests have their shortcomings. For one, they leave a lot of patients in the gray intermediate-risk zone. Also, the tests aren’t applicable to the 25%-35% of breast cancer patients with estrogen receptor–negative tumors. But a host of new technologies are in the pipeline, he observed..."

ruthbru

Good Grief......so basically no one knows what ladies on aromatase inhibitors should do after 5 years.....I am done and I guess I will just stay done.....

besa

The full text of the the article comparing 10 years of tamoxifen to 5 years appears in the October 5th issue of Lancet.

  It would be nice for an article like this to be offered to us for free but they are charging for access. There is a link to the abstract of the article below. 

http://www.lancet.com/journals/lancet/article/PIIS0140-6736(12)61963-1/fulltext

http://www.lancet.com  (brings you to the journal web site)

'Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial'

voraciousreader

ruth....This was the ATLAS clinical trial....There are NUMEROUS more studies in the works....Don't lament!  Check out pages 93-98 of the NCCN breast cancer guidelines 2012 professional version...it discusses the various endocrine studies that are in the works. In the next year or two, there should be more information regarding AI's....  I know that doesn't help you now....but as a history buff I know you can appreciate when I say, "Stay calm," as the Queen Mother would say, "and carry on!"  I applaud you for completing 5 years of the AI!  Cheers!

gpawelski

Combining molecular analysis, chemosensitivity testing & therapy monitoring?

It was suggested in a paper by Dr. Katharina Pachmann that was presented at the ASCO trade show, about combining molecular analysis, chemo sensitivity testing in vitro, and therapy monitoring in vivo on disseminated tumor cells (CTC) in breast cancer patients.

Dr. Katharina Pachmann was the investigator who reported at an annual San Antonio Breast Cancer Symposium in 2004, using the CTC technique, German investigators showing that neoadjuvant chemotherapy with paclitaxel (taxol) causes a massive release of cells into the circulation, while at the same time reducing the size of the tumor. The finding helped to explain the fact that complete pathologic responses do not correlate well with improvements in survival (Oncol News Int'l, Vol 14, #5, May '05).

Two years before this, Dr. Christos Kosmas, published a study "Carcinomatous Meningits: Taxane-Induced" which found what is called "dissemination after taxane-based (taxol) chemotherapy. the study concluded that Carcinomatous Meningitis (a CNS metastasis) after a major response to front-line taxane-based regimens represents a grave disease manifestation and its incidence appears increased when compared retrospectivley to non-taxane-treated patients (American Journal Clinical Oncology 2002;63:6-15).

Monitoring CTCs could be utilized for confirmation after the patient is administered assay-directed most beneficial therapeutic agents.

Combining molecular analysis, chemosensitivity testing in vitro, and therapy monitoring in vivo on disseminated tumor cells in breast cancer patients.

http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=74&abstractID=52031

voraciousreader

Greg....Could you please elaborate....Thanks!

Beesie

Here's a good summary of the research that led to the conclusion that 5 years of Tamoxifen was better than 10 years:  

Tamoxifen: Five Versus Ten Years—Is the End in Sight?

A possible explanation of why the current study comes to a different conclusion can be found in this paragraph:

"At the recent NIH Consensus Development Conference, representatives from the Early Breast Cancer Trialists' Collaborative Group argued that the survival benefit from 5 years of tamoxifen therapy, rather than remaining constant, continues to increase during the next 5 years (carryover effect), despite the drug being stopped. The carryover effect would be expected to minimize differences between the two arms of B-14 during the first 5 years of follow-up. An advantage for prolonged therapy, they reasoned, might be expected to emerge after 10–15 years of follow-up. Supporting this viewpoint, more recurrences did occur in the placebo group (n = 16) than in the tamoxifen group (n = 11) in B-14 when only recurrences diagnosed more than 6 years after randomization were examined."

Still, it would be interesting to know if the full report on the study explains why these results differ from that of previous studies. 

wallycat

And it is important to note that the study was funded by tamoxifen-type drug makers (that is what CBS news stated).

voraciousreader

Wallycat... If you click on the link for the first press release that I posted, it says that the study was funded by a consortium that included Astra Zeneca. The United States Army and the European Union were among the contributors.

coraleliz

AstraZeneca was the oringinal marketer/mfg of Tamoxifen. They no longer make it. It's only available in generic, so it's interesting that they provided funding. Out of the goodness of thier heart? Generics have been available for Tamox for along time. I do think it was worth studying. Not sure if it was mentioned here or on another thread, perhaps there are subsets of BC patients that can benefit & the rest- not so much. 

Some of us have been given a small % of reoccurence & anything short of eliminating any chance of reoccurance may not change our minds.

Thanks for starting this thread. I'll check in again

LovesDogs

voraciousreader:

So happy to find this threae; thanks for posting this!  I had tenatively planned to go to the SABCS (I live in Austin), but had too many conflicts this week.  I figured I'd hear about the highlights after the fact. 

LovesDogs

voraciousreader

Lovesdogs...I am soooo jealous of you living in Austin!  I was there for Thanksgiving visiting my youngest son who lives there!  Years ago, I knew, the moment he stepped off the plane to attend UT, he was never coming back!  Believe me....had I been able to stay an extra week or two....I would have loved to have gone to the symposium!  Maybe next year.....

Coraleliz...Notice in the Boston newspaper article excerpt that I posted above, that one of the doctors mentioned that for those patients with "small un-aggressive tumors" might only wish to take tamoxifen for 5 years because the risk of recurrence is small.  I am going to take a closer look at the Lancet article (at my library - next week) and see if I can parse from the study EXACTLY who these patients were.  How many had Stage 1 Grade 1 disease and so forth....I think that would be the only way to figure out if the benefits exceed the risk of taking the drug for many more years.  My guess right now is that for those sisters who have little side effects from taking Tamoxifen, regardless of tumor aggressiveness, we are going to see more sisters encouraged to continue endocrine therapy.  I foresee a day, based on this evidence, that it will become a lifelong drug, not unlike statins...IMHO...

Beesie...I had read that the studies conducted on the 5 years of Tamoxifen included smaller sample populations AND the earliest studies compared 5 years of Tamoxifen to 2 years of Tamoxifen.  It took many more YEARS to realize that "carry over effect" AND that it would be worthwhile studying being on Tamoxifen for a longer period of time....

This kind of study illustrates the need to come up with better ways of doing clinical trials...because the BEST clinical trials take decades and need to include vast numbers of participants....which ultimately costs lots and lots of money.  Eric Topol, MD touches on this subject in his TERRIFIC book, The Creative Destruction of Medicine.  He says in the book, he envisions a future that clinical trials will be genomically done involving fewer people.  It sure would have been nice if this study said, "Sisters with OncotypeDX recurrence scores of 30 and above derrived the most benefit from taking Tamoxifen for 10 years" rather than each sister having to figure out if the sample population pertained to her... 

cp418

Well Tamoxifen was approved back in 1977, so it has been around a long time.  I am disappointed that it took so many years to gather this information and come to this conclusion.  Likewise, it would be interesting if these drugs have a carry over protection effect then why can't a patient take it in intervals - one year on/off?  Get more time mileage from it.  Lastly they always push the safety aspect but I've never seen numbers for how many patients ended up with hysterectomies due to complications.  More surgery required to prevent possible uterine cancer.  Now waiting to see what they may/may not say about AIs or will we have to wait until next year. 

voraciousreader

"About 3 percent of the women who took 10 years of tamoxifen, however, developed endometrial cancer -- a known problem caused by the drug -- which was about double the rate of those who took tamoxifen for fewer years. Endometrial cancer is rarely life threatening and is usually treated with surgery."

http://www.boston.com/dailydose/2012/12/05/should-breast-cancer-patients-have-decade-tamoxifen/qTb1ynlNgl0jewwXNvubyM/story.html

lago

It will be interesting for me. I was peri-menopausal but my onc put me on Anastrozole instead of Tamox knowing that I was so close (based on my mom & sister) that I wasn't going out of chemopause. She tested me for several months. Last period was September 2010, 2 weeks before my 1st chemo TX. Not sure if being triple positive has anything to do with this either.

So I was peri-meno but not put on tamox.  Won't be seeing my onc till April and it may be a new one because my insurance dropped my treatment center. (Still in negotiations but they've been negotiating over a year. I'm not holding my breath).

I really don't want to be on this for 10 years!

cp418

"About 3 percent of the women who took 10 years of tamoxifen, however, developed endometrial cancer -- a known problem caused by the drug -- which was about double the rate of those who took tamoxifen for fewer years. Endometrial cancer is rarely life threatening and is usually treated with surgery."

Yes - However, as a patient taking this medication many are required to have yearly or bi-yearly vaginal US to monitor. So more Dr appts and scans to add to our stress. Again, many women here reported getting hysterectomies due to complications while on this drug - - and  had surgical intervention to prevent possible further problems.  So maybe this news is not really all that exciting.  None of these medications "kill" cancer but simply block it for some patients and not for others.......  

voraciousreader

CP418.... However, if the goal is to avoid recurrence and additional surgery and treatment, then considering continuing endocrine surgery makes sense...especially in light of the fact that uterine cancer is a less serious illness for most women than breast cancer. I guess you need to put it into perspective and pick your poison. Not an easy choice.

wallycat

CP418, I am with you.  Are we trading one problem for another?  I also find it interesting how "excited" these reporters/doctors are when looking at the printed abstract, it seems at best, a 3% benefit.  Funny how when they were looking to see if I should do chemo, I had 3 doctors tell me 4% or less benefit was not worth doing chemo, so I didn't.  Now 3% PLUS all the side effects seems to be "exciting and new" information.  BAH!  I also thought about the spreading out of treatment.  If tamoxifen works for 10 years after, why not do another 5 years at the 10 year mark...and maybe every other year.....and since Evista works similarly to tamoxifen without the uterine/ovarian problems, why are they not looking at THAT as a recurrence preventing (for er+) med??

Yes, very unfair that not only do we get cancer, we have to do the work for individualizing it for ourselves...that doctors don't have these tools yet.  Sigh.

lago

The SE from Chemo is more severe IMO than the SE from an extra 5 years on Tamoxifen. Granted I still didn't want to do Tamox.

susan3

I was on tamoxifen 5yrs then femera. My cancer biologically changed over that course and became hormone refractory. but I am THRILLED i was able to have drugs to keep my going since 2002. have raised my daughter and lived a full life. I have a great marriage so it was fun trying to figure out the "sex" stuff cause of dryness, and the bone and joint pain becomes the new you. We only have one life, I will live it any way I can..One of my docs is headed up the conference and speaks at it. I give them all credit, they are doing the best they can and I applaud them.

Jennt28

Re: pharma funding of non-pharma studies... Yes, the pharma companies do provide funding for these. It is not out of "the goodness of their heart" but because they know that a good study will still garner them some publicity.



I coordinate clinical trials and both of my studies have some pharma funding (Novartis and Bayer), however aside from a regular update on accrual and advising them of upcoming publications (in which they have to be mentioned as having provided some funding), they have NO input into the studies.



Without this kind of funding Investigator Initiated Research would be almost impossible!